If you communicate with your therapist through written messages, the platform may allow you to message synchronously, so you receive instant responses during a live session, or asynchronously, for which replies may not necessarily be immediate.
Live Video Sessions
With live video sessions, you will meet with your therapist on a secure video platform during your appointment time with your camera enabled.
Live Phone or Voice Sessions
With live phone or voice sessions, you will meet with your therapist during your appointment time for an audio-only call. Platforms and providers differ in how they offer audio-only therapy. You could have your session on a video platform with the camera disabled, or your therapist could call you.
Synchronous Messaging
Like with live video and audio sessions, synchronous messaging involves meeting with your therapist during your appointment time but for a live chat session without the use of audio or video. During your chat therapy session, you will message back and forth in real time.
Asynchronous Messaging
Some online therapy platforms include unlimited messaging to your assigned therapist. This communication is asynchronous. Your therapist will respond when they are able, whether that’s in a few minutes or in a few days, depending on the platform and therapist.
Telepsychiatry
Some mental health platforms offer telepsychiatry in addition to teletherapy. According to the American Psychiatric Association, telepsychiatry can involve mental health evaluations, therapy, and potential medication. If you’re interested in mental health medication, you will first meet with a physician or psychiatrist, depending on the platform, to see if it’s right for you. If they prescribe medication, they will either coordinate prescriptions for pickup at your local pharmacy or have them delivered to your door. During your follow-up sessions, they will see how you’re doing on the prescription and determine whether they need to adjust your treatment plan. If you see an in-network therapist with your insurance, you will be responsible for paying any copays, coinsurance, or deductibles required by your plan. Some therapists and online therapy platforms do not accept insurance and instead will charge you a set amount per session or offer sliding scale payment, in which your income determines how much you pay per session.
Can You Use Insurance to Pay for Teletherapy?
Every insurance provider and plan differs in how it covers teletherapy. According to the Maryland Insurance Administration (PDF), in-network providers have an agreement with your insurance company to provide services at a certain amount. Contact your insurance company or benefits administrator directly to confirm whether a platform or provider you’re considering is in network. If you utilize your out-of-network benefits for teletherapy, your provider will bill you directly instead of billing your insurance. If your provider gives you a superbill, an itemized bill of the services you received, you can file a claim with your insurance company for potential reimbursement. Your exact coverage depends on your plan’s out-of-network benefits. You can use a flexible spending account (FSA) or health savings account (HSA) to pay for your teletherapy as long as it is for a medical or mental health purpose, according to the FSA Store. Marriage counseling and family therapy don’t typically qualify without a letter of medical necessity, defined by Patients Rising as a letter issued by a doctor verifying a medical need for a service. Some online platforms accept FSA and HSA cards, including BetterHelp, Talkspace, Sesame, and MDLive. If your carrier doesn’t issue an FSA or HSA card, you can submit your receipts to them for reimbursement like you would for any other eligible expense.
DepressionPost-traumatic stress disorder (PTSD)AnxietySubstance useEating disordersAdjustment disorder, which is a stress-related condition caused by events or problems in your life, according to the Mayo Clinic
Krystal Smith, a licensed therapist in Hoover, Alabama, notes that individuals experiencing severe symptoms of psychosis or those at an immediate risk of harm to themselves or others should seek emergency care in person.
Pros
Opens up more mental health care options for those in remote areasAddresses issues with transportation and commute times compared with in-person therapyVideo, phone, email, and chat messaging options may make it more convenient than in-person therapy
Cons
Requires a reliable internet connection and a private place for sessionsInsurance coverage varies among platformsNot suitable for emergencies or crises
Whether You Want to Use Insurance Some platforms accept insurance, and others don’t. The insurance companies they work with also vary. If you’re looking for an online therapist who accepts insurance, check with your insurance carrier to verify coverage details before you sign up for therapy.Your Budget Breaking down your monthly expenses can give you an idea of how much you can afford.Session Format Decide whether you would feel more comfortable with video, chat, or audio-only therapy sessions.Therapy Frequency Many teletherapy platforms offer weekly therapy sessions, while others offer sessions twice a month, monthly, or a la carte.Length of Sessions Session lengths can vary but typically last 30 to 55 minutes depending on the platform or therapist you choose.Whether You Want to Pay per Session or per Month Some online therapist platforms charge per session, while others charge for a monthly subscription upfront.Whether You’re Considering Mental Health Medication Some teletherapy platforms offer plan options that include telepsychiatry, so you can meet with a licensed prescriber online to receive mental health medication.
You can also reach out to the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-HELP (4357). The SAMHSA help line is a free, confidential, 24/7, 365-day-a-year treatment referral and information service for individuals facing mental or substance abuse disorders.
